HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 8 -D ). i � % Permit Number: / & 0,? "Q k J
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Building Pe
plication NAR 212918
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line RC6f
Address: I rq gig / NIIeY les A i M � F
Legal Description: /Ve-tt ley Ts land _ nC
Hm Uk. sbafe- i n bmMon edemem s
PropertyTax ID #: 4I56a - 56) - I LI'ig -0UO-
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
DE -TAILED DESCRI�PTI®N'OF WORK`
--Remove P-0SVIAl -"hln9le,ro6.� _- miglac,
ack FL
- secfin"
Left Side:
o and
Lot No.
Block No.
w �-}h new meiq l ('DO + . o Y
ep-i rnp
Additional work to be
❑HVAC
nertormed
Gas Tank
under this permit - check all
[]Gas Piping
I
apply:
Shutters
❑ Windows/Doors
❑Electric
❑
Plumbing
❑Sprinklers
❑
Generator
❑
Roof
fz
Roof pitch
Total Sq. Ft of Construction: �) S . Ft. If First Floor:
Cost of Construction: $ 4400 Utilities* wer Septic Building Height:
0`WNER/L�ESS'EE�:&'
C®NRACT®R;
_{r �.
ri
Name
Name: ie. SCib
Compan�, : �_ Una n i2o 624 L
Addresss-� `p0 J
City: NIP) State:EL
Address: la %i ;4/e#) .S 611)J
City: TnSen _FWt` k State:
Zip Code: 3ACts7 Fax:
Phone No. -7-7cl- to I ' f1Q 8:a
Zip Code:l - '` Fax: _
Phone No.7^%c�.- 0195
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail: I oo
from the Owner listed above)
State or County License: CCU 7 w,
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codeslland St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of (Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Ow r
Signature of Coritractor/License Holder
STATE OF FLORIDA
STATE OF FLORI A
COUNTY OF GA Lvt�t e_
COUNTY OF S� Luc `lie.
The forgoing instrument was acknowledg efore me
i
The forgoing instrum nt was acknowledged before me
this d"L day of Feb vary 20IV by
t I aE day of 20 by
r�n den �� rc,Ma-rYi
1 e , s Co
Name of person making statement
I Name of persoraking statement
Personally Known OR Produced Identification ✓
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced I ger)S0—
Priduced
(Signatu of No
(Signat re of Not ubli - S a e o F o a
eoy Pya Notary Public State of Florida
Commission No. r° °�Marilyn Klued�leal)
gY P�
°.F a4 Nota ubl' State of Florida
Commission No. _ ; MariI
a My Commission FF 230179
%sO�o Expires 06/28/2019
gel
oQ My Commission FF 230179
NoF+F�°4
I
Expires 06/28/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
i
Rev. 8/2/17